HomeMy WebLinkAbout2422 Decla~ation ot Domicile a~d Citisenship 1473~3 _
~
TO THE STATE AND COUNTY TAX ASSESSOR: ~ ~
Sl. IUCIE COUNTY, FLORIDA: +
This is my declaration of Domicile and ~itizenship in the State of Florida that I am filing th~s day in accordance and
in co~formity with Chapter 222, Section 222.17, Flotida Statutes.
Nex York
I was formerly a legal resident of ____BY'OOklyTi _ _
~C;ty~ (State)
A`~~ p• However I have chan ed m domiGi~e
and I resided at 9 Y
(Street and Number) ,
to and am and have been a bona fide resident of the State of Florida since 29~_ day of
J~ 19 and I reside at _ 1~8 ~ipOla Rd.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORfDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and do~~~icile in the State of Florida.
(Insert he~e any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
Stintering Tiro A~ildren in 3chool
FI~EO AND RECOROED
gT~RECORO VERI~ E0~
~ti~~ ~
'~6 4 AM ~0 ' y7
14'7393
;;p;~i? ?'OITRAS
CLERK CIRCUIT COURT ~
c
~ ~
t
~
~ I FURTHER CERTIFY that t wil) mmply with all other requirements of a legal resident of this State. ~
!
FURTHER CERTIFY that I have no intention to return to my former domiG~e, and I intend to remain in FORT ~
,a-=_
PIERC[s~8l4H~T,~,~UCIE COUNTY, FLORIDA, permanently. ~
~L1 i. r.
` ;.y~~~:•~:~ ' • Bernard Selkin
~
~ ~ ~ = , _ (Name)
• v V L~
~ s~ • - _ ' • '.v_ / `
~ . ~ (Address)
~ 'n 1 ` '1 ,
.
~ wugust
,Sworn to and subscribed before me this day of . 19
~
~ ~
~ ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
gy ll~ _ ~ D.C. My Commission expires
~
~
(To bs ~xecuted in duplicate and originsl ~iled with Clerk Circuit Cour~, and duplicaM with Tax Ass~ssor.)
go~K 152 21
~.ku~ ~ ~ ~ ~ : _ ~ r:v~
~P~,
A~: r~~ .